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PUBLIC HEALTH SERVICES SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E. Weber Ave. , Third Floor, Stockton, CA 95202 <br /> (209) 468-3420 <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br /> Facility Name]1241 ( ELI , IS('S program ID# � 3 [ � � <br /> Facility Address,3:-�3 A). 0tS City Y--]Lc fOvt zip <br /> UST: Dual Wall Single Wall OVERFILL: Audible Visual_Mechanical <br /> PIPING SYSTEM: Dual wall Single wall suction Pressure >< Gravity <br /> DOES THE LEAK DETECTION SYSTEM meet 23CCR 2636 (g) requirements? YES NO_ _ <br /> VIOLATIONS <br /> TANK # <br /> UST GENERAL REQUIREMENTS <br /> Permit to Operate [H&SC 252841 <br /> Forms A & B Current 7H&sc 25284 c <br /> monitoring/maintenance Records 23CCR 2712 b <br /> Monitoring Records Available 23CCR 2712 <br /> Monitoring Plan [23CCR 2632 (d) (1) <br /> Res-nons Plan F22CCR 2632 (d) (2) 1 11 <br /> Unauthorized Releases Reported [H&SC 252951 <br /> Monitoring Equipment Annuai Cert. 23CCR 2630 ( <br /> Over spiii Container <br /> Cathodic Protection 23CCR 263S (a) (2) (A) ] (t <br /> New USTs Monitored Continuously [23CCR 2630] <br /> MANUAL INVENTORY RECONCILIATION (MIR) <br /> 2943-11 1 <br /> I <br /> meters a ibrated [23CCR 2646 (i) l <br /> Gaucrincr Stick in 1�8 inches f23CCR 2949 (c) (1) t } <br /> Monthly Variations Calculated [23CCR 2646 (d) ] <br /> Ex-Variation Procedure Foliowed L23CCR 2646ke) ] <br /> ST STICAL INVENTORY RECONCILIATION (SIR) <br /> Inconclusive Procedure Followed [23CCR 2646.1 (d) ] <br /> UST Integritv Test Every Two Years 23CCR 2646. 1 (g) <br /> Annual SIR Report [23CCR 2646.1 (j) ] <br /> ai y Stick Reading c > <br /> Monthly ATG Results [23CCR 2643 (b) (1) ] <br /> Annual Summary Report <br /> MANUAL UST TANK GAUGING (MTG) <br /> Tank Gauging Weekly [23CCR 2645 (b) ] <br /> Annual a n egri y Test <br /> Tank auging Procecture PoIlowed <br /> Daily SuctionPiping Monitoring F2 R A -III <br /> Piping Tightness Test 23CCR 2643 b c d <br /> Gravity Piping Tested Every 2 Years [23CCR 2643 (e) ] <br /> Month y Line Test L23CCR 2643 c 2 <br /> Annual x Detector Test L <br /> TANK REMOVAL <br /> Permit to Close or Cease Operation H&SC 25298 <br /> Removed, Ciosed or Temporar y Closed 23CCR 2670 <br /> REHS INSPECTION DATE/TYPE: <br /> RECEIVED BY: PHONE: <br /> Revised Date 7/1S/97 23 CCR UST Regs May S, 1994 PAGE i� of <br /> PHS 231(9197) <br />